Jehovah's Witness

Aka: Jehovah's Witness, Jehovah Witness, Bloodless Medicine

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II. Definitions

  1. Jehovah's Witness
    1. Religious denomination founded in the U.S. in the late 19th century
    2. As part of religious beliefs, Jehovah's Witnesses generally refuse Blood Transfusions and other blood-based treatments
      1. Practices vary, and some patients agree to albumin, Clotting Factors and IVIG but refuse cellular products
  2. Bloodless Medicine
    1. Practice to reduce the risk of life threatening Anemia in the perioperative period

III. Management: Preoperative Care

  1. Increase baseline Hemoglobin prior to surgery
    1. Supplement in the weeks before elective surgery
      1. Iron Supplementation
      2. Vitamin B12 Supplementation
      3. Folic Acid supplementation
    2. High risk bleeding procedures
      1. Epoetin Alfa 600 units/kg each week for 4 weeks
      2. Biosimilar agent Retacrit does not contain Albumin (in contrast to Epogen, Procrit)
  2. Hold medications that increase bleeding risk (if possible)
    1. See Medications to Avoid Prior to Surgery
    2. Anticoagulants
    3. Antiplatelet Agents
    4. NSAIDs
    5. Ginkgo Biloba
  3. Indications for preoperative Desmopressin
    1. Platelet Dysfunction
    2. Uremia

IV. Management: Perioperative Care

  1. Limit blood loss
    1. Cell Salvage Autotransfusion Devices (e.g. Cell Saver)
    2. Minimimally Invasive Surgical Procedures
    3. Avoid Hypothermia (increases risk of Coagulopathy)
  2. Consider Hemostatic Agents
    1. Consider Tranexamic Acid
    2. Have Topical Hemostatic Agents readily available
      1. Fibrin Sealants (e.g. Tisseel)
      2. Topical Thrombin (e.g. Recothrom)

V. Management: Postoperative Care

  1. Limit postoperative blood draws
    1. Consider pediatric blood tubes
    2. Consider point of care finger stick levels
  2. "Bloodless" Agents that increase Hemoglobin
    1. Parenteral Iron (e.g. Venofer) in Iron Deficiency
    2. Epoetin Alfa in severe Anemia
      1. Effects are delayed by at least 4 days
  3. Other measures for life-threatening Anemia (e.g. Hemoglobin <5 g/dl)
    1. Hyperbaric Oxygen
    2. Bovine Hemoglobin-based oxygen carrier (e.g. Hemopure IV)

VI. References

  1. (2024) Presc Lett 31(2): 10
  2. Crowe (2019) Curr Opin Hematol 26(6):473-9 +PMID: 31453819 [PubMed]
  3. Rashid (2021) Curr Opin Anaesthesiol 34(2):125-30 +PMID: 33577206 [PubMed]

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